En bloc resection by polypectomy with over-the-scope clip for a neuroendocrine tumor located in a duodenal bulb pocket.

Abstract

Neuroendocrine tumors (NETs) are located primarily in the submucosal layer and require careful resection. Conventional endoscopic mucosal resection (EMR) has a risk of positive deep resection margins. En bloc resection is more feasible in endoscopic submucosal dissection (ESD); however, in the duodenum, there is a heightened risk of intraoperative or delayed perforation owing to the thin duodenal wall and effects of inflowing bile and pancreatic juices [1]. The use of an over-the-scope (OTS) clip during polypectomy can greatly reduce the perforation risk [2] and is reportedly safe for duodenal NETs [3]. However, its use during polypectomy to resect NETs located in the pocket of a duodenal ulcer scar has not been reported. We report the use of this method for the safe, rapid, en bloc resection of such tumors located in the anterior wall of the duodenal bulb ([Fig. 1], [Fig. 2], [Video 1]).